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Attacks on Science: The Risks to Evidence-Based Policy

This was the first assignment given to us by our professor in the course, Political Dynamics of Health Policy class (HPS221). He didn't ask us to write a paper about what we think but rather read the article and we will discuss it in class. I wrote what I think about the article in my www.healthactivist.ph blog since I believe that we weren't able to discuss the assignment thoroughly and me unable to explain well why we need to settle the definition of "evidence-based" policy.

Attacks on Science: The Risks to Evidence-Based Policy

1.
⏐ ETHICS AND PUBLIC HEALTH ⏐
American Journal of Public Health | January 2002, Vol 92, No. 114 | Ethics and Public Health | Peer Reviewed | Rosenstock and Lee
AS GOVERNMENT AGENCIES,
academic centers, and their re-
searchers increasingly provide
the science base for policy deci-
sions, they are also subject to
forces that seek to politicize or si-
lence objective scientific re-
search. We refer not to the hon-
est differences and conflicts that
arise in response to scientific un-
certainty, but to the pressure to
use science to justify policy (even
when the data are inadequate),
as well as the vulnerability of sci-
ence to attacks driven by vested
interests—interests that exploit
scientific uncertainty to deflect
attention from what is known
and from the actions that would
credibly follow that knowledge.
Attacks on science are not
new. Galileo, for example, was
charged with “vehement suspi-
cion of heresy” and put on trial
in 1633 when he was 69. To
save his life, Galileo publicly re-
nounced his belief that the sun,
not the earth, was the center of
the universe. In 1992, after more
than 350 years had passed, the
Vatican deferred to Galileo’s sci-
entific theory and granted him a
full pardon.1–3
As attention and respect for
scientific research grow, attempts
both to overdetermine scientific
findings and to undermine the
policy implications of sound sci-
ence are becoming increasingly
sophisticated and complex, put-
ting evidence-based policymak-
ing at risk.
USING SCIENCE FOR
POLICY MAKING
The increasingly global econ-
omy is influencing investments in
research, scientific publications,
and research alliances.4
US
health research and development
funding has increasingly shifted
from public to private sources.
Between 1965 and 1995, the
proportion of health research
and development funded by fed-
eral sources dropped by almost
half, to 37.4%, while industry’s
financial support increased more
than 2-fold, to 52% of the total
$35.8 billion expended.5
Nearly
12% ($1.5 billion) of research
funds to academic institutions
now come from the corporate
sector.6
Universities are also in-
creasingly turning to Congress as
a direct source for research fund-
ing; universities and their lobby-
ists have secured more than $7
billion since 1980 through con-
gressional earmarks inserted into
spending bills.7
Meanwhile, the public is
demonstrating an increasing in-
terest in technology and health.
Developments in medicine and
health care outranked moral val-
ues, the stock market, national
policies, and television content in
a recent survey of the issues that
most affect peoples’ lives.8
Ap-
proximately 1 in 5 people in the
United States consider themselves
very well informed about the use
of new inventions and technolo-
As government agencies, aca-
demic centers, and researchers af-
filiated with them provide an in-
creasing share of the science base
for policy decisions, they are also
subject to efforts to politicize or si-
lence objective scientific research.
Such actions increasingly use so-
phisticated and complex strategies
that put evidence-based policy mak-
ing at risk.
To assure the appropriate use of
scientific evidence and the protec-
tion of the scientists who provide it,
institutions and individuals must
grow more vigilant against these tac-
tics.Maintaining the capacity for ev-
idence-based policy requires differ-
entiating between honest scientific
challenge and evident vested inter-
est and responding accordingly,
building and diversifying partner-
ships, assuring the transparency of
funding sources, agreeing on rules
for publication, and distinguishing
the point where science ends and
policy begins.
Attacks on Science:
The Risks to Evidence-Based Policy
| Linda Rosenstock, MD, MPH, and Lore Jackson Lee
gies and 40% have a great deal
of confidence in the leadership of
the scientific and medical com-
munities, a level that is far higher
than levels reported for the lead-
ership of other major institutions
in society.4
This trust may be at
risk, owing to a number of forces
that are arrayed to influence the
use of scientific evidence.
TACTICS USED TO
UNDERMINE SOUND
SCIENCE
A wide array of vested inter-
ests—and here we mean those
who, for whatever reason, are
committed to a predetermined
outcome independent of the evi-
dence—may drive the undermin-
ing of sound science to forestall
the policy implications that would
necessarily follow. These inter-
ests, which are often financial but
may also be emotional, ideologic,
and political, may be acting alone
or in combination. Although eco-
nomic interest is a common moti-
vation and may drive both corpo-
rations and individuals (e.g.,
lawyers, physicians), emotional in-
terests have played an increasing
role in undermining sound sci-
ence to achieve their desired
ends (as in the case of victims’
groups). The role of corporate in-
terests has been best reported, at
least in part because of the signif-
icant economic resources corpo-
rations can bring to bear to influ-
ence policy outcomes.

2.
⏐ ETHICS AND PUBLIC HEALTH ⏐
January 2002, Vol 92, No. 1 | American Journal of Public Health Rosenstock and Lee | Peer Reviewed | Ethics and Public Health | 15
orders of the back, neck, and
upper extremities.19
Although the National Acad-
emy of Sciences study heartily
supported NIOSH’s conclusions,
in fiscal year 1999 Congress
again asked the academy to re-
view the same issues.20
Not sur-
prisingly, since the large scientific
data base remained the same,
the second review corroborated
the conclusions of the first.21
The
delay process proved ultimately
successful when one of the first
acts of the incoming Bush admin-
istration was to withdraw the
long-delayed but just-finalized er-
gonomics standard that had been
promulgated in the last weeks of
the Clinton administration.
Hidden Identities
In attacking science, vested in-
terests may also hide their identi-
ties by masquerading as grass-
roots coalitions or by affiliating
themselves with neutral organiza-
tions. Consider, for example, the
National Coalition on Ergonom-
ics, a research group that op-
poses a national ergonomics stan-
dard; the Food Chain Coalition,
which represents the pesticide in-
dustry and works to prevent reg-
ulations; Doctors for Integrity in
Research and Public Policy, phys-
icians who oppose gun control
and handgun research; and the
Center for Patient Advocacy, the
orthopedic group that lobbied
against the Agency for Health
Care Policy and Research’s back
treatment recommenda-
tions.14,15,22,23
Most recently, what
had appeared to be a grassroots
coalition striving to raise aware-
ness about the hepatitis C virus
was actually shown to be a mar-
keting effort run by the pharma-
ceutical company Schering-
Plough Corp to promote their
product, Rebetron, which is the
primary hepatitis C therapy.24
Economic Manipulation
First and foremost, vested in-
terests may use money to inhibit
or stall sound science. The in-
creasing role of industry-spon-
sored research, despite its many
benefits, also raises concerns. At
the extreme are instances in
which an industry sponsors re-
search with the direct goal of
countering existing scientific opin-
ion. Economic interests may ad-
versely affect scientific integrity
through the delaying or withhold-
ing of research results and by di-
rectly or indirectly influencing the
content of results.
In a survey of more than 3000
scientists in the 50 universities
that received the most National
Institutes of Health funding in
1993, 20% of respondents re-
ported delays of more than 6
months in the publication of their
research results at least once in
the previous 3 years to allow for
financial interests, such as patent
applications, or to slow the dis-
semination of undesired results.9
Another study of corporate in-
vestments in academic research
found that donors often expect
the right to prepublication review
of research results, ownership of
patent rights, and future consult-
ing relationships.10
Still other studies have found a
strong association between au-
thors’ opinions and their financial
affiliations. A review of studies
on selected chemicals (alachlor,
atrazine, formaldehyde, and per-
chloroethylene) found that 60%
of studies conducted by nonin-
dustry researchers found these
chemicals hazardous, while only
14% of industry-sponsored stud-
ies did so.11
A review of 70 arti-
cles about the use of calcium-
channel antagonists found that
96% of the authors supportive of
their use had financial relation-
ships with manufacturers of cal-
cium-channel antagonists, com-
pared with 60% of neutral au-
thors and 37% of critical au-
thors.12
A study of review articles
on the health effects of passive
smoking found that 74% of those
who disclaimed the widely held
view of the relationship between
health effects and environmental
tobacco smoke had affiliations
with the tobacco industry.13
Federal research is not im-
mune to this type of economic in-
fluence, which is usually brought
to bear through congressional
channels—often in response to
vested interests—mostly through
specific appropriations or barriers
to appropriation. A program or,
occasionally, an entire agency
may become the victim of such
efforts. The Department of
Health and Human Service’s
Agency for Health Care Research
and Quality, then known as the
Agency for Health Care Policy
and Research, was slated for zero
funding in fiscal year 1996 after
an organization of orthopedic sur-
geons, angered over the agency’s
science-based recommendation of
nonsurgical approaches for man-
aging acute back problems, lob-
bied Congress.14
Similar efforts
were launched by the same Con-
gress to eliminate or reduce fund-
ing for the Centers for Disease
Control and Prevention’s National
Center for Injury Prevention and
Control and the National Institute
for Occupational Safety and
Health.15,16
Vested interests also use hired
scientists, on a full-time or very
lucrative part-time basis, for spe-
cial tasks that aim to derail the
use of sound science. Ongoing to-
bacco lawsuits uncovered a to-
bacco industry investment of
$156000 to hire more than a
dozen scientists to write letters
and manuscripts discrediting a
1993 federal report that linked
secondhand smoke to lung can-
cer. These “for hire” materials
appeared in the likes of the Jour-
nal of the American Medical Asso-
ciation, the Journal of the National
Cancer Institute, Risk Analysis, the
Journal of Regulatory Toxicology
and Pharmacology, and the Wall
Street Journal.17
Pharmaceutical
companies have employed simi-
lar tactics, paying for favorable
articles and editorials.18
Delay
When economic manipulation
fails to influence research, vested
interests turn to a complex arse-
nal of delaying tactics to forestall
the release or influence of scien-
tific evidence. These tactics in-
clude initiating litigation, fighting
for access to raw data, funding
parallel studies, inundating re-
searchers with administrative pro-
cedures, and catalyzing congres-
sional reports or inquiries. One of
the favorite delay tactics is de-
manding greater or different peer
review, such as invoking the Fed-
eral Advisory Committee Act to
fault agency approaches to peer
review.
A prime example is an ongoing
effort to retard work on the de-
velopment of a national occupa-
tional ergonomics standard. Since
fiscal year 1995, the heavily lob-
bied Congress had either pro-
posed or passed ergonomics rid-
ers to the Occupational Safety
and Health Administration appro-
priations, prohibiting or delaying
work on development of the stan-
dard. In 1998, Congress also
commissioned a National Acad-
emy of Sciences study to review,
among other things, a 1997
study released by the National In-
stitute for Occupational Safety
and Health (NIOSH) that found a
positive relationship between spe-
cific work activities and the de-
velopment of musculoskeletal dis-

3.
⏐ ETHICS AND PUBLIC HEALTH ⏐
American Journal of Public Health | January 2002, Vol 92, No. 116 | Ethics and Public Health | Peer Reviewed | Rosenstock and Lee
Vested interests have also
found ways to infiltrate profes-
sional organizations under the
guise of academic neutrality. This
can have serious ramifications
for national policy, since the cre-
dentials and expertise of profes-
sional organizations give them
high credibility. The International
Commission on Occupational
Health, which assists in the de-
velopment of scientific and policy
recommendations, recently fell
victim to this strategy when sev-
eral members with a vested in-
terest in the asbestos industry
used their affiliation with the
commission to develop an Inter-
national Labor Organization doc-
ument that was unusually favor-
able to the industry.25,26
Harassment
In their efforts to squelch un-
wanted scientific findings, vested
interests have also been known
to harass investigators, federal
agencies, and even the scientific
and policy-making processes
themselves.27,28
For example, a
pharmaceutical company, using
a variety of approaches, was suc-
cessful in delaying for years the
publication of research results
negative to its thyroid treatment
product.29
A researcher at
Toronto’s Hospital for Sick Chil-
dren was sued by a pharmaceuti-
cal company for publishing her
negative conclusions about one
of the company’s products.30,31
A
Brown University academician
and physician became involved
in a similar controversy when he
discovered a cluster of cases of
interstitial lung disease among
workers at a local textile flocking
industry plant.32
The latter inci-
dent is particularly worrisome
because the employing institu-
tion did not support the right of
a faculty member to publish
findings, citing the murky restric-
tive covenant that he had
signed.33
It is not only commercial inter-
ests that have learned the bene-
fits of harassment. To cite just
one example, a group of victims
of multiple chemical sensitivity
very publicly attacked the scien-
tific integrity of authors who
published findings that there was
no evidence for an immunologic
basis for multiple chemical sensi-
tivity.28
A CASE STUDY
OF TACTICS
A case study that illustrates
the majority of the strategies dis-
cussed above involves an epide-
miologic study of diesel exhaust
and lung cancer, jointly con-
ducted by NIOSH and the Na-
tional Cancer Institute. The study
is important not only to the more
than 1 million US workers who
are regularly exposed to diesel
exhaust, but to the millions of
people worldwide, particularly in
the developing world, who are
exposed both at work and in the
nonwork environment to diesel
exhaust.
After conducting a joint feasi-
bility study, NIOSH and the Na-
tional Cancer Institute initiated
peer review of the study protocol
in 1995. It was not until 1998,
however, that the study actually
began. Despite evidence of diesel
exhaust’s potential carcinogenic-
ity and a strong study design, the
Methane Awareness Resource
Group, a coalition of mine own-
ers and operators and other in-
dustry representatives, initiated
litigation in 1996 asserting that
the peer review process violated
the Federal Advisory Committee
Act.34
When multiple subsequent
legal efforts failed to block the
study, the group lobbied Con-
gress to include language in the
fiscal year 1998 appropriations
bill that required both agencies
to review the issues once more.35
Additionally, there were attempts
to insert more peer review, a
fight for access to raw data so
that the industry could simulta-
neously analyze these data and
run its own parallel study, public
harassment of the study peer re-
viewers, copious Freedom of In-
formation Act requests, and pro-
motion of congressional inquiries
into the most minute details of
the study design.
The net result is that an impor-
tant study with broad occupa-
tional and environmental implica-
tions has been delayed by many
years. In addition, the constant
need to defend the science and
the scientific process resulted in
decreased attention paid to other
public health efforts.
RESPONSES TO THREATS
TO SCIENCE
The threats to science are ex-
ceedingly complex and inter-
twined. We propose that the sci-
entific community increase its
awareness of the existence of
these threats and that it mount
institutional responses, rather
than the issue-by-issue reactions
that are now the norm. It is our
hope that the responses sug-
gested here will generate discus-
sion among universities, profes-
sional societies, government
agencies, and individuals about
the best ways to ensure the ap-
propriate use of scientific evi-
dence and the protection of the
scientists who provide it.
First, consider the context and
the source of the attack. It is cru-
cial that we respond appropri-
ately to honest scientific chal-
lenges as opposed to challenges
issued by vested interests. We
currently tend to react too defen-
sively to both, and as a result, the
economically and politically pow-
erful can too easily compromise
the use of good science. Again, it
is important to recognize that al-
though commercial interests are
sometimes the most obvious
sources of attack, others with
vested interests (e.g., victims’
groups and their lawyers) may
adopt the same tactics.
Second, the scientific commu-
nity should build and diversify its
partnerships, especially in contro-
versial areas. Appropriate in-
volvement, early in the process,
of potential critics who are hon-
estly seeking scientific answers
helps forestall later unfair attacks.
The field of occupational safety
and health, for example, is now
implementing the National Occu-
pational Research Agenda, an ef-
fort launched during a period of
agency vulnerability.36,37
Some of
the harshest critics of a federal
role in workplace research are
now engaged in guiding and sup-
porting this effort.38,39
Third, institutions and individ-
uals should strive to ensure the
transparency of funding sources
and an appropriate balance of
neutral funding between the pub-
lic and private sectors. Funding
should follow well-delineated
guidelines to protect the integrity
of the research process—particu-
larly important given the wide
variability in conflict-of-interest
reporting and policies among the
major biomedical research insti-
tutions in the United States.40
Institutions should agree on
rules for publication of research
results well in advance to ensure
the timely and uninhibited dis-
semination of scientific findings.
Financial disclosure and recusal
requirements should be univer-
sally implemented for peer-re-
viewed journals and publications,
whose policies currently vary

4.
⏐ ETHICS AND PUBLIC HEALTH ⏐
January 2002, Vol 92, No. 1 | American Journal of Public Health Rosenstock and Lee | Peer Reviewed | Ethics and Public Health | 17
13. Barnes DE, Bero LA. Why review
articles on the health effects of passive
smoking reach different conclusions.
JAMA. 1998;279:1566–1570.
14. Deyo RA, Psaty BM, Simon G,
Wagner EH, Omenn GS. The messen-
ger under attack—intimidation of re-
searchers by special interest groups. N
Engl J Med. 1997;336:1176–1180.
15. Kassirer JP. Partisan assault on sci-
ence: the threat to CDC [editorial]. N
Engl J Med. 1995;333:793–794.
16. Rogers D. GOP steps up efforts to
cut funding for US agencies opposed by
its allies. Wall Street Journal. July 13,
1995:A12.
17. Tobacco industry paid scientists to
criticize report. Washington Post. August
5, 1998:A2.
18. Brennan TA. Buying editorials. N
Engl J Med. 1994;331:673–675.
19. Bernard BP, ed. Musculoskeletal
Disorders (MSDs) and Workplace Fac-
tors: A Critical Review of Epidemiologic
Evidence for Work-Related Musculoskele-
tal Disorders of the Neck, Upper Extrem-
ity, and Low Back. Cincinnati, Ohio: Na-
tional Institute for Occupational Safety
and Health; 1997. Also available (in
PDF format) at: http://www.cdc.gov/
niosh/ergosci1.html. Accessed Novem-
ber 8, 2001.
20. National Research Council. Work-
Related Musculoskeletal Disorders: A Re-
view of the Evidence. Washington, DC:
National Academy Press; 1998.
21. National Research Council and In-
stitute of Medicine. Musculoskeletal Dis-
orders and the Workplace: Low Back and
Upper Extremities. Washington, DC: Na-
tional Academy Press; 2001.
22. OSHA struggles to develop rules
governing ergonomics hazards. Wall
Street Journal. June 16, 1998:A1.
23. Unreasonable Risk: The Politics of
Pesticides. Washington, DC: Center for
Public Integrity; 1998:24.
24. O’Harrow R. Grass roots seeded by
drugmaker; Schering-Plough uses “coali-
tions” to sell costly treatment. Washing-
ton Post. September 12, 2000:A1.
25. LaDou J. ICOH caught in the act
[editorial]. Arch Environ Health. 1998;
53:247–248.
26. Castleman BI, Lemen RA. The ma-
nipulation of international scientific or-
ganizations [editorial]. Int J Occup Envi-
ron Health. 1998;4:53–55.
27. Russell RH. In the not-so-public-in-
terest: is science for hire (and fire)? Con-
servation Matters: Journal of the Conserva-
tion Law Foundation. 1998;5:27– 30.
28. Daniell W. Science, integrity, and
investigators’ rights: current challenges.
widely. One recent survey showed
that only 43% of medical journals
had policies requiring disclosure
of conflicts of interest.41
We
should establish additional guide-
lines to support investigators’ right
to publish; bar prohibitions
against publication; and require
carefully structured, third-party
review for industry-funded re-
search on industry products.
Professional societies should
set limits on the extent and cir-
cumstances of industry sponsor-
ship and should raise awareness
of the scope and magnitude of
threats to science. Individuals
should increase their vigilance
about accepting gifts, speaking
fees, and travel; should be clear
about implicit or explicit expecta-
tions of private sponsors; and
should be careful to ensure that
any signed agreements conform
with basic institutional require-
ments for reporting, disclosure,
and conflicts of interest.
Fourth, and perhaps most im-
portant, we must be on guard to
distinguish the point where sci-
ence ends and policy-making be-
gins. Consider, for example, the
1998 White House decision not
to fund needle exchange pro-
grams and the 1997 National In-
stitutes of Health decision regard-
ing breast cancer screening. In
the case of the needle exchange
programs, although emotional
and ideologic vested interests
had worked successfully to un-
dermine the scientific database,
the cumulative evidence was
clear in finding that such pro-
grams do not increase drug use
and do reduce cases of HIV.42
The administration recognized
the science but nonetheless re-
fused to lift a ban on federal
funding of needle exchange pro-
grams.43,44
Thus, policy was
driven by political factors, not
scientific ones, and the distinc-
tion was clearly acknowledged—
no attempt was made to hide the
decision behind the caveat of sci-
entific uncertainty.
Compare this episode with the
development of breast cancer
screening guidelines. A National
Cancer Institute consensus panel
concluded that the science was
inadequate to support routine
screening of women aged 40 to
49 years.45
Yet, in response to ex-
ternal pressure from a variety of
vested-interest groups with finan-
cial and emotional commitments
to screening, the science was re-
visited and repackaged, resulting
in the recommendation that
women in their 40s be screened
every 1 to 2 years.46
Both of
these examples involve a variety
of complex issues, but the bottom
line of both is the same: there is a
need to more rigorously define
and clarify the boundary be-
tween science and policy.
Taking steps to protect our-
selves against threats to science
requires effort, and it would be
naïve to assume that science can
ever be truly free of vested inter-
ests and influences. But it is clear
that if we fail to act, we lose an
opportunity to strengthen the
credibility of scientific evidence in
policy-making and to protect sci-
entific researchers and research.
The ability to maintain the capac-
ity for evidence-based policy is vi-
tally important to our society.
About the Authors
Linda Rosenstock is with the School of
Public Health, University of California
at Los Angeles. Lore Jackson Lee is with
the School of Public Health and Health
Services, George Washington University,
Washington, DC.
Requests for reprints should be sent
to Linda Rosenstock, MD, MPH, School
of Public Health, University of Califor-
nia at Los Angeles, PO Box 951772,
Los Angeles, CA 90095-1772 (e-mail:
lindarosenstock@ph.ucla.edu).
This commentary was accepted August
27, 2001.
Contributors
L. Rosenstock conceptualized the main
points and wrote the paper. L.J. Lee pro-
vided background research and con-
tributed to the writing of the paper.
Acknowledgement
The authors would like to thank Dr Jo
Ivey Boufford for her critical review of
and comments on an earlier version of
this commentary.
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